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 For example, black and Hispanic women with breast cancer were less
likely than white women to select surgeons and hospitals based on
reputation, researchers found.
The differences in how people select healthcare providers may help
explain racial differences in use, delivery and quality of medical
care, the researchers write in JAMA Oncology.
“Disparities in breast cancer and cancer care are very complex,”
said Dr. Rachel Freedman, the study’s lead author from the
Dana-Farber Cancer Institute in Boston.
She and her colleagues asked 222 non-Hispanic white women, 142
non-Hispanic black women and 136 Hispanic women from Northern
California to identify the reasons they chose their surgeons and
hospitals. The women were diagnosed with breast cancer between 2010
and 2011.
Overall, most women said they chose their surgeon based on their
doctors’ recommendations, and they picked their hospital because of
their health plan.
On closer analysis, the researchers found 19 percent of black women
and 87 percent of Spanish-speaking Hispanic women listed their
doctors’ recommendations as a reason for selecting their surgeons,
compared to 76 percent of white women.
Overall, they found that black and Hispanic women were less likely
than white women to factor in the reputation of their surgeons and
hospitals when making their choices. Minority women, however, more
often said they factored in their doctors’ recommendations.
“We also noted that white women were more likely to select multiple
reasons than one or two reasons for hospital or provider
selections,” Freedman said. “We don’t know the reasons for that, but
what that may suggest is that white women may be more active in
selecting providers when determining their cancer care.”
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While they can’t say how these differences factor into later care,
Freedman said the recommendations from doctors may become very
important and determine women’s remaining care.
“It possible that initial point of referral is very important for
treatment and trajectory,” she said.
The next step would be to look at what kinds of care the women are
getting to get a better understanding of how this all matters,
Freedman said, adding that doctors may need to tailor their
approaches for different women.
She said there may not be anything wrong with a more passive style
of doctor and hospital selection they found among black and Hispanic
women, she said.
“We just don’t know,” she said, adding that existing literature
suggests people who are more active in healthcare are also more
engaged.
“Not all patients operate that way and can still get good care,”
Freedman said.
SOURCE: http://bit.ly/1CEYRE4 JAMA Oncology, online March 20, 2015.
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